<form class="well form-horizontal" id="purchase" action="/paymentGateway/order" method="post">
    <div class="alert alert-block alert-error" id="purchase_es_"
         style="display: none">
        <p>请更正下列输入错误:</p>
        <ul>
            <li>dummy</li>
        </ul>
    </div>
    <p class="note">
        <span class="required">*</span>为必填项
    </p>

    <fieldset>
        <div class="control-group accout_info all_a"
             style="margin-bottom: 20px;">填写账户信息
        </div>
        <div class="control-group ">
            <label class="control-label required" for="Customer_law_name">
                客户姓名
                <span class="required">*</span>
            </label>

            <div class="controls">
                <input class="input-xlarge" name="Order[customer_name]" id="Order_customer_name" maxlength="64"
                       type="text">
                <span class="help-inline error" id="Order_customer_name_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group">
            <label class="control-label required" for="Order_id_type">证件类型
                <span class="required">*</span>
            </label>

            <div class="controls">
                <select name="Order[id_type]" id="Order_id_type">
                    <option value="0">--请选择--</option>
                    <option value="1" selected="selected">身份证</option>
                    <option value="2">护照</option>
                    <option value="3">通行证</option>
                    <option value="4">军官证</option>
                </select><span class="help-inline error" id="Order_id_type_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label required" for="Order_idno">证件号码
                <span class="required">*</span>
            </label>

            <div class="controls">
                <input class="input-xlarge" name="Order[id_no]" id="Order_id_no" maxlength="255" type="text">
                <span class="help-inline error" id="Order_id_no_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_email">E-mail</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[email]" id="Order_email" type="text">
                <span class="help-inline error" id="Order_email_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_commodityName">商品名稱</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[commodityName]" id="Order_commodityName" type="text">
                <span class="help-inline error" id="Order_commodityName_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_commodityUrl">商品URL</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[commodityUrl]" id="Order_commodityUrl" type="text">
                <span class="help-inline error" id="Order_commodityUrl_em_" style="display: none"></span>
            </div>
        </div>

        <div class="control-group ">
            <label class="control-label required" for="Order_commodityUnitPrice">商品單價
                <span class="required">*</span>
            </label>

            <div class="controls">
                <div class="input-prepend input-append">
						<span class="add-on"><?php echo $config['mer_currency'];?>
						</span><input append=".00" name="Order[commodityUnitPrice]" id="Order_commodityUnitPrice"
                                      type="text"><span class="add-on">.00</span>
                </div>
					<span class="help-inline error" id="Order_commodityUnitPrice_em_"
                          style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_commodityQuantity">商品數量</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[commodityQuantity]" id="Order_commodityQuantity" type="text">
                <span class="help-inline error" id="Order_commodityQuantity_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label required" for="Order_transferFee">運輸費用
                <span class="required">*</span>
            </label>

            <div class="controls">
                <div class="input-prepend input-append">
						<span class="add-on"><?php echo $config['mer_currency'];?>
						</span><input append=".00" name="Order[transferFee]" id="Order_transferFee"
                                      type="text"><span class="add-on">.00</span>
                </div>
					<span class="help-inline error" id="Order_transferFee_em_"
                          style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_commodityDiscount">優惠資訊</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[commodityDiscount]" id="Order_commodityDiscount" type="text">
                <span class="help-inline error" id="Order_commodityDiscount_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label required" for="Order_orderAmount">交易金額
                <span class="required">*</span>
            </label>

            <div class="controls">
                <div class="input-prepend input-append">
						<span class="add-on"><?php echo $config['mer_currency'];?>
						</span><input append=".00" name="Order[orderAmount]" id="Order_orderAmount"
                                      type="text"><span class="add-on">.00</span>
                </div>
					<span class="help-inline error" id="Order_orderAmount_em_"
                          style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_cutomerCardNumber">持卡人卡號</label>

            <div class="controls">
                <input class="input-xlarge" name="Order[cutomerCardNumber]" id="Order_cutomerCardNumber" type="text">
                <span class="help-inline error" id="Order_cutomerCardNumber_em_" style="display: none"></span>
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" for="Order_remark">附言</label>

            <div class="controls">
                <textarea class="input-xlarge" style="resize: none;" rows="5"
                          name="Order[remark]" id="Order_remark"></textarea>
                <span class="help-inline error" id="Order_remark_em_" style="display: none"></span>
            </div>
        </div>
        <div class="alert alert-block">
            <a class="close" data-dismiss="alert" href="#">×</a>
            <h4 class="alert-heading">提示</h4>
            <dd>如对支付有任何问题,请直接相关的例句我们的客服联系.</dd>
            <dd>客户在完成付款后,可将含有交易编号的页面列印(如没有印表机的本公司亦接受抓图的电子档案),之后再寄交或电邮(cs@demo.com)本公司,以便加快处理贵客户的付款.</dd>

        </div>
        <div class="control-group ">
            <div class="controls">
                <label class="checkbox" for="Order_term">
                    <input id="ytOrder_term" value="0" name="Order[term]" type="hidden">
                    <input name="Order[term]" id="Order_term" value="1" type="checkbox">
                    我已阅读并同意接受<a href="javascript:void(0);">免责声明</a>
                    <span class="help-inline error" id="Order_term_em_" style="display: none"></span>
                </label>
            </div>
        </div>
        <input name="ctype" value="0" type="hidden">

        <div class="form-actions">
            <button class="btn btn-primary" type="submit" name="yt0">
                <i class="icon-shopping-cart icon-white"></i> 生成订单
            </button>
            <button class="btn" type="reset" name="yt1">
                <i class="icon-refresh"></i> 重新输入
            </button>
        </div>
    </fieldset>
</form>
<!-- form -->